“I’ve seen it all.” said one ICU nurse who’s been here 30 plus years. I though to myself, “see what?”. And then I suddenly knew what she was talking about.

On my 2nd week orientation things seem to be on “cruise control”, until we hear a “trauma code ER” call over the PA system. A few minutes later they send the patient up from the ER. As always, everybody jumps in to assist the admitting nurse… “Let’s go!” said my preceptor.

Laying on the stretcher was a young gentleman in his late 20’s, intubated, with a cervical collar, motionless. We transfer him to his bed via spinal board that was smeared with dry blood. We attached the monitors as the ER nurse gives status report to the admitting nurse. Behind the patient’s head a bloody towel… it was 08:30 and we have a self inflicted gun shot wound to the head… what a way to start your day. 😦

As the day wore on family slowly trickles down to the ICU. You can see the expression on their faces… teary eyed, shocked, and in disbelief. You turn your thoughts to your own family, then remember what you’ve been taught in nursing school. As nurses we’re to empathize with our patients, their family, and what they’re going through, but we can’t let our emotions get the better of us. It was a truly sobering sight to see this young man laying lifeless on his bed, on a vent… a life cut short needlessly.

As more information came in, we find out the cause of his apparent decision to end his life… all we could do was shake our heads and say “it’s not the end of the world”, but not for him… apparently the pain was too much to bear. We detach ourselves and focus on the task at hand… keep his vital organs alive, there may still be hope for others.

Coming home that day I couldn’t help but think about that young man, his family, and the significant others in his life who are needlessly grieving right now, and for a minute I feel their loss.

Only 2 weeks in the ICU and I’m beginning to see things I wouldn’t have seen would I have been too scared to venture out and take the plunge. I then realize that in the long road ahead, I too will eventually “see it all”.

Just like our good Lord who walked the earth around 2000 years ago… He saw it all, and is still seeing it all. The suffering and pain that we had to go through is not foreign to Him… He suffered too, and is still suffering with us. It’s just too bad nobody reached our young patient in time to say, “it’s not the end of the world buddy, there’s hope.”

Times like these we reflect, and move on. This is the side of nursing most of us don’t get to see… the side of nursing we don’t want to take home… the side of nursing that’s beyond us and makes us realize that we are part of a greater whole, and I’m blessed to be part of that. We have an opportunity here to help ease the pain and suffering our fellow humans go through with the little acts of kindness and compassion we can show them. This is not a SERVICE EXCELLENCE show… this is the real deal.

If you think you can do more and would like to, come to the ICU! 🙂 I’m sure you have what it takes deep inside of you. Just put your fear aside and focus on the reason we’re here. We may not get a medal of honor, or be awarded for our services, but let me assure you, the joy of service and the satisfaction of helping a suffering fellow human being gives you far more rewards than awards can ever give.

03/01/2007 Update

During the afternoon session of our ICU class we heard a loud wailing from the hallway. It was definitely a young lady crying uncontrollably. Later on that afternoon we found out that our young patient has just gotten out of the OR after a few hours in there while surgeons performed the harvesting of his remaining vital organs that will give life and hope to someone in need. A sad day indeed for this young man and his grieving family… a life lost… some lives saved… was it a fair trade?

A few of my colleagues were reminiscing about some of the fellows who’ve come and gone, where they work and how they’ve been. Interestingly enough some of their fellow co-workers have been around. Some still working at their previous jobs, some have moved on to “bigger and better” places, yet some just couldn’t get settled and go “job hopping”, moving around in a big circle just to find themselves back at the same job they left. I guess the saying holds true… “the grass is always greener on the other side” or so it seems. 🙂

This is particularly true down here in the Valley. We have hospitals and facilities popping all over the place like mushrooms, and the number of health related facilities and businesses that need RNs spread like wildfire. Thanks to this trend, the demand for nurses is getting higher and higher everyday, however, the supply remains at an all time low. I guess you can say that the distribution of resources is unequal and the goods, i.e., RNs migrate to the highest bidder.

Nurses are an odd bunch. Since they are so scarce, they get to go around. Some find themselves leaping from one job to the next, moving from facility to facility (depending on who pays the most), while others stay at their place of employment for 30 plus years! During the brief exchange I made a common observation… that is… these nurses leave a facility to work for another facility who pays them a lot more, however, as they left, some would bad-mouth the former place of employment and essentially burning their bridges in the process. For all it’s worth, I don’t think that would be a smart move on their part, just for the fact that we don’t know what the future holds and we may find ourselves knocking at their door asking for our job back. I know this for a fact because I was once in their shoes.

I’m sure that most of us have gone down that road before… yes, we’ve burned some bridges, and I’m sure looking back all we see is frustration and regret. However, we shouldn’t dwell on the past but hopefully learn from the experience and move on… it’s kinda hard to get to your destination if you’re driving looking through the rear view mirror all the time. Looking back, I’d say most of what I’ve gone through was not burning my bridges, but rather, burning my boat.

A person’s boat can be anything that represents comfort. Job wise, it was 5 West for me… this was my boat. I loved my boat. I took care of my boat. I took care of the people and guests that were in my boat. I even took the trash out of my boat. And after rowing for 2 years in my boat, thinking that I was a valuable part of the crew, I got pushed off board. Splash! What do you do? You burn that boat and start swimming to dry land!

It’s a scary thought, but this is the only way we can learn and grow. I’ve seen it happen many times before. I’ve worked with a number of good nurses, CNAs and other members of the health care team. I’ve seen what they can do, and I can see what they are capable of doing. Unfortunately most of them are too scared to venture out… too scared to leave the comfort of their boat. I often ask them, “what are you still doing here?”. Maybe it’s about time to ask yourself… “what are you still doing here?”.

Today marks my first day of orientation, I’m officially an ICU nurse, and I’m thinking to myself, “boy, what took me so long?”.

I remember that day 6 months after I started working at 5 West, I asked the former director if I could take the ICU class. She told me I had to wait until my first year. Odd I thought to myself, my colleague of less than 8 months was able to take the class, and I was here first. I guess the former director thought that if I took the class, I’d put in my transfer request to ICU. I wouldn’t think that would be possible though, knowing that she and the former ICU director were in cahoots, my former director would have put in a bad word… after all, she considered me a “trouble maker”. I considered this a complement since people that have a brain and can think for themselves, and is not satisfied with status quo are usually branded as such–“trouble makers”. 🙂

I’m sure it doesn’t come as a surprise to me (and my new director) that my transfer came smoothly without a fuss. I called the HR department to find out how transfers were usually processed. I’d have to write HR a letter stating intent, then give a copy to my director. It turns out, my former director did all the legwork as soon as he got my written request. That was fast… unfortunately I was not notified until 2 days before my official transfer date. I had to come to him and ask him “Wassup?!”. 🙂 Talk about communication breakdown. Wouldn’t it be nice to know what’s going on for a change?

The ICU is not as intimidating as it looks from the outside. The classes are there to help you get accustomed to the environment and equip you with the core knowledge you’ll need to be able to function in that setting. Most nurses dislike being floated to ICU (me included) since it can be quite intimidating without the proper training. This all changed when I saw the cohesiveness of the team and how they helped each other. I guess the turning point for me was when I actually observed the director giving patients baths to help out the staff, and when she took time to thank me for coming down to help.

I suppose I should thank Alicia, the charge nurse that day, who decided it was my turn to float (although I disagree with her decision), it was a blessing in disguise. Thank you Alicia! Hey, maybe you can do yourself a favor and float down here sometime. 🙂

So here I am… my new home. Yes, I’m home! I believe this is where I belong… this is what I’m called to do. The team spirit is great, and our director treats us like the adults we are and encourages us to pursue professional advancement. By the way, you should come down here and meet her, and finally get to meet a real director. On that note, you should come down here and see how a unit should be run. This is the real MMC… this is how it should be.

Like me, you’ll never know what you’re missing if you stay where you are… Thank you Alicia, I owe you this one! 🙂

They say parting is such sweet sorrow. I guess they (whoever “they” are) were right.

I’ve always considered 5 West my home floor… always been loyal to the people and patients that make 5 West… always been proud to be at 5 West. For the last 2 years I’ve been at 5 West I’m glad to have been part of what 5 West has become… but now it’s time to move on and take up other challenges. I guess my work here is done.

To all the people who make up 5 West, particularly the night crew I say THANK YOU!

Thank you for making the last 2 years a very pleasant and enjoyable one. It has been a pleasure to be surrounded by such a fine group of individuals who go above and beyond what is expected of them.

Despite this there is always that possibility that we will meet again, knowing very well that staffing at MMC (and other hospitals for that matter) is largely volatile and floating is inevitable. There is also that ICU to Telemetry transfer that I’m sure most of you are just thrilled to have anytime 🙂 . Then again there’s that occasional pop in visit just to say “Wassup?!”

People come, and people go. What matters is the state of things when we leave. I’m hoping that 5 West gets better as the days go by, and I know it will because I was there, and I’ve seen how we’ve made progress.

If there’s anything I’ve learned in the past 2 years it is this… 5 West, take care of your own! Your asset is the people who define what 5 West is. You have been blessed to have the finest, don’t let it go to waste. Value your resources, i.e., the people who truly care about the state of things. Be open minded and have a heart. Listen and actually do something.

Swallow your pride and learn from other Units who know how to take care of their people (kudos 6 East). If you can do this, you’re halfway there! Till then, you’ll be plagued with poor staffing, low staff morale, and a team that’s as divided as night and day!

We can pat ourselves in the back for being one of the Top 5% of hospitals in the nation (depending on which survey you choose to believe)…

We can tell the competition to “eat their heart out” and use these ratings as a clever marketing scheme to get the Valley’s patient population market share…

We can have a fifty foot banner in red, white and blue and decorate the side of our hospital for everyone to see our achievement…

We can even point them to the website and ask them to call us so they can know more about our top 5% excellence rating…

Sure the accolade is great, and I’m sure our Directors are proud. They might even get a plaque of appreciation for a “job well done” where they can display in their ivory towers.

They can even strut around in their nice white lab coats, head held up high and carry their trophies taking pictures with the “privileged few”. Heck, we can even feature that on our Weekly Doze (I mean) Weekly Dose employee newsletter 🙂 .

I guess that’s all nice, fine and dandy. But let me ask you this…

When was the last time your Director stood up for you?

When was the last time they defended your right to have a safe and pleasant work experience?

When was the last time they were truly concerned about your welfare, or wellbeing, or professional growth or advancement?

When was the last time they rolled up their sleaves, got down and dirty with the patient, and actually did patient care because you were short staffed… a condition which they should be able to remedy?

When was the last time they valued you more than a “contracted” agency nurse? (Nothing against agency nurses, you’re just doing your job.)

I don’t know about you, but I think we have our priorities all mixed up, especially when we talk about taking care of your own!

One night while floated to the Unit, I was greeted by a lady who aparently recognized me as an unfamiliar face.

She welcomed me and was kind enough to show me around, pointing here and there where I can find stuff, revealing the key codes that unlocked the doors for the supply and medication rooms. She thanked me for coming down there to help them out.

This was the lady I saw earlier, dressed in scrubs, giving bed baths to the patients. Then she said, “by the way, I’m… Director of ICU”. Director of ICU? It’s 22:30, most directors are asleep by now, heck, they don’t even answer their pagers or voicemails after 1900. They don’t even call you back when you need them.

I thought to myself…

Finally a Director who has balls enough to be a part of the solution and not just pass the buck around with empty promises and “I just work here” attitudes…

Finally a Director who empathizes with her staff and isn’t afraid to get down and dirty on the floor…

Finally, a Director who will earn the respect of her staff because of what she does, and not what her title says…

Being Top 5% on the outside isn’t bad. It may probably bring in the much needed revenue this hospital needs due to the dip in census blamed on a fairly new hospital which opened in the area.

But then again, top awards don’t mean anything, especially to those who know work conditions aren’t as ideal as it should be. That Top 5% Award is like a whitewashed tomb… beautiful to look at on the outside, but inside full of dead men’s bones!

Director… where does your loyalty lie?

Would you be loyal to us like we are loyal to you and our unit?

Would you put our patient’s needs first before you figure out how much supplies we need to cut so you can have a larger bonus check at the end of the year?

Would you be concerned about staffing the floor right so everyone gets a fair share of the workload, or would you rather cut staff short and spare that extra RN’s salary so you can show better “productivity” for your unit?

Would you actually listen to your staff’s concerns and view them as an opportunity to improve your unit and maybe create a more cohesive team?

Would you have the guts to stand up for your unit and defend your own staff?

It’s the last tab before you’re done and only one item left, then suddenly, a error… a screen pops up and states there is a Javascript error on line 15 on the page. You lose 30 minutes worth of Admission Data entry. That’s Opus Clindoc for you!

In a situation like this, how can you recover the data you entered? You can’t. It’s just a sample of poor programming…period! And for a system that’s supposed to be the Rolls Royce of EMRs, I don’t think there was very good planning involved.

The number one rule for all IT and critical data application is backup, backup, backup. You can also say redundancy, redundancy, redundancy (not trying to sound redundant 🙂 ). I suppose all that bloated AJAX code got to their head… then all of a sudden, you have this system costing thousands of dollars, which quite frankly does a good job frustrating and aggravating users, who are the very people it is supposed to help. Unfortunately all IS can come up with is a lousy excuse about how every decision has to come from “corporate”, talk about passing the buck! Besides, IS don’t have to use this piece of software engineering genius everyday, we do. So why can’t they fix it?